斜卧位经超声引导行微通道经皮肾镜碎石取石术

目的探讨斜卧位经超声引导行微通道经皮。肾镜碎石取石术治疗。肾结石的安全性和可行性。方法肾多发性结石或鹿角型结石患者12例，其中重度肾积水者6例，轻中度肾积水者4例。行患侧输尿管逆行插管，患者仰卧于自制体位架并固定，患侧抬高450，腰部向患侧突出，显露腋中线至肩胛下角线。经12肋下超声引导进行穿刺、扩张建立16～18F经皮肾通道，采用输尿管镜行弹道碎石取石术。结果12例碎石取石术均成功，手术时间（143．5±41．2）min，出血量（204．2＋45．6）ml，1例术中输血200ml。无术中大出血，无肾盂穿孔、气胸、结肠损伤等并发症，一期结石取净8例（66．7％），其余4例二期MPCNL取净。结论斜卧位经超声引导行MPCNL，患者体位舒适，便于术中麻醉监护；超声引导可提高穿刺成功率，并有效避免血管及脏器损伤。斜卧位经超声引导行MPCNL安全可行，适合在基层医院推广。

Mini-pereutaneous nephrolithotomy under ultrasoud guidance in semi-supine position

Objective To evaluate the safety and availability of mini-percutaneous nephroliethotomy treating renal stones. Methods 12 cases of mutiple renal stones and stag-horn calculus patients including 6 cases with severe hydronephrosis, and 4 with mild to moderate hydronephrosis. A ureteral catheter was inserted retrogradely, then the patient was placed in semi-supine position on a self-made board. The ipsilateral flank was raised 45 degree during the procedure, exposing puncture was made sub-costally guaided by ultrasound, dialated to 16 to 18 F and a working channel was established, then nephrolithotomy was performed through the channel under ureteroscope. Results Lithotomy was successfully carried out in all the 12 cases, the operative time： （143.5± 41.2）min, blood loss： （204.2±45.6）ml, one case with blood transfusion of 200 ml. No complications such as huge blood loss, renal pelvic perforation, pneumothorax and colon injury occured. 8 cases completely removed all the stones within one stage operation （with a stone free rate of 66.7%）, 4 cases need secondary MPCNL to clear all the residual stones. Conclusion In mini-percutaneous nephroliathotomy under ultrasound guidance in semi-supine position, patients can be placed in a comfortable position, easy to be monitored by anesthetist. Ultrasonic guaidianee can improve puncture achievement rate and avoid vessel and visceral injuries, it is a safe procedure and can be prevalently adopted in primary hospitals.